so frustrated with docs/when and when not to page

pricklypear · May 20, 2005

I'm thinking it was studentdoctor.com that you found. That place is... Well, I can't go there because I get too angry.

We all struggle with the "protocol" issue. I kind of have a run-through I do before I call anyone in the middle of the night

1. Is the patient in any immediate danger?

2. Is the patient symptomatic?

3. Is there anything that can be done about this problem at 2am?

4. Is this a new thing? Or has this patient had this "problem" all day?

If I still can't decide, I ask around.

If you answer Yes to any of these, you should probably call.

pebbles, BSN, RN · May 20, 2005

If you answer Yes to any of these, you should probably call.

Agreed - and try to learn not to feel badly about paging a doctor. That's their JOB, to be on call, and they all knew it was part of the job going into it. You are paging the doc because you need physician support to take good and safe care of your patients. Don't ever let an angry doc make you feel badly about that.

You'll get to know what things can wait till morning, or even if a certain doc would rather be paged, etc... try asking the seniour nurses you work with for advice if you are undecided whether to page.

If you have several patients being taken care of by the same doc, group all the concerns so all can be addressed by one phone call.

pricklypear · May 20, 2005

Pebbles is right, DO NOT let them make you feel bad about calling on something you feel is important. And a word about when your patient demands that you call the Dr, you really have to. It's their choice. Not doing it, in my opinion is witholding care. If you really don't want to, and the patient is completely coherent, tell them to call through the operator.

Another thing - DO NOT say "I'm sorry to bother you" or "I'm sorry to wake you" It irritates them, at least the ones I work with! Get straight to the point.

If you really cannot decide, it all boils down to this: you can lose your license for not calling on something that turns out to be important, but you won't lose it if you call for something they don't think is important.

Nesher, BSN, RN · May 21, 2005

You are the patient's advocate - call away.

zambezi, BSN, RN · May 21, 2005

I agree, I do think that if you have a bad feeling or the patient is symptomatic or having issues you need to call....but not if the issue is constipation or a sleep aid at 2:00 am...there are other things you can try that do not need a dr's order (but make sure you get what you need the next day). As for the example you used, that is where critical thinking comes in...if a patient's bp is low, you need to see how low. Is the patient "normally" hypotensive? Was the patient given a sleeping pill with his nightly betablocker and the bp was taken while asleep? what has the bp been running over the last few days? is there a big change now compared to the previous few days? look at the patient-> do they feel ok? can you feel peripheral pulses (consistant/changed from prior asssessments?). is the urine output low? is the patients color good? what about skin temperature- are they cool/mottled or diaphoretic? is there cyanosis present? all of these things come into play...if the patients bp is running low (80-90) systolic at night, I don't get too worried, unless this is really different for the patient or they are symptomatic...i usually won't call for it...sometimes even for a bp in the 70s if they are alseep and have been started on new cardiac meds (but it really depends on the situation and how the patient looks and is feeling)...

If a doc needs to be called then call. Don't feel sorry for it. It is better to err on the side of caution, it is your license at stake. Always document when you call for a change in condition, if there are no new orders write that too. That being said, don't call for everything or something that can wait until the morning...these docs have to sleep too...think through what you are calling for. Try what you can first...if you are able to do a nursing intervention or there are standing orders use up those first. Make sure you inform the doc of the interventions that you have tried. If you think that you might have an issue later in the night (you see a trend, you know that patient can't sleep, etc)...call early and get the orders you need before the doc goes to bed...they will remember it (most of the anyway...)

talaxandra · May 21, 2005

The first thing to think about is why you're there - to promote the best outcome for the patient, through your own actions and an advocate. If contacting a doctor will improve the patient's outcome then page away!

I've had my share of unhappy residents complain about being paged but, as previous members have posted, that's part of their job.

I do prepare, to make the process as easy as possible - most recent blood result if I'm ringing for IV hydration orders, for example. After all, we all know that they're busy, too.

Sometimes colleagues have said that looking up blood results is the doctor's job, but I think that it's not only my responsibility to know what the patient's values are, having the results available also expedites the process and achieves my aim (which is getting an order for what I want for my patient :))

About the hypotension - if it's an ongoing problem then the unit or the cover need to clearly document that in this case the reportable BP is now x/x. Problem solved! Until that's documented, in writing, by a doctor, you still have a duty and an obligation to notify the medical staff:

"I appreciate that you've been contacted about this on half a dozen occasions, but unless a different reportable is documented, I have to keep contacting you. Maybe you could discuss this with the unit. Now bite me!" (I'm very popular )

UM Review RN, ASN, RN · May 21, 2005

Got the link? I'd love to explain a couple of things.

RoxanRN · May 21, 2005

When I'm calling for something outside of the ordered parameter, the conversation tends to go somthing like this -

"Hi, I'm calling about Jane Smith in Neuro 8. Her b/p is 187/88 and the call parameters are ordered for SBP > 180. She was running in the 140s-150s during the day, but now has been trending upward since 10pm and it's been above 180 consistantly now for 1 hour." [/i]

It covers the who, what, when, where and why I'm calling. I usually don't have many irritated docs. If they are irritated, it's the ones who tend to be irritable even face-to-face during the day.

Roxan

z's playa · May 21, 2005

I made a mistake a couple of days ago...I decided to google "doctor/nurse relationships" and stumbled upon a physician based message board where the docs were *****ing about nurses paging them for stupid things in the middle of the night, etc etc. They also questioned if nurses even had critical thinking skills/what did they actually learn in school, becase of the types of things nurses page for...an example was a nurse who paged about a pt's b/p being low, and per protocal she paged the doc for the low b/p. The doc was angered because this pt's b/p "just runs low" and was consistently low for the past week or so...so obviously he wasn't going to do anything about it, why in the world would she page him in the middle in the night for something so stupid...etc etc. BUT, I would have paged the doc too! PER PROTOCOL I need to page the doc, and document that I paged the doc for this b/p. I'm a relatively new nurse who works night shift (actually 2 years now) and I STILL struggle with this issue, I never know when it is appropriate to page. I mean, I know I shouldn't page for a Colace order at 3am, and I know to page for emergency situations, like respiratory distress, etc....however there are many things in the middle where you just aren't quite sure if you should be waking the doc up at 3am for certain issues/or bothering them when they are in the ED/OR. I feel like there are so many things we need to page on (cover our a--) and document for legal issues, but there is also this fine line where you aren't sure if its really APPROPRIATE. I guess the fact that I'm not a well seasoned nurse adds to this struggle of mine, and its probably one of the most frustrating parts of my job. I don't like to bother people, and I'd be really upset if a doc yelled at me for paging him "for something stupid". It bothers me to hear these doctors complaining about the nurses in this way, ...they just don't even consider what we are going through! What about the fresh post op patient with nausea who is refusing to take the Anzemet already order for them, and DEMANDING that you page the doc for Reglan at 2am?!?! Its just SO frustrating...I'm so sick of being the middle man...anyone else struggle with this or have any advice on how to deal with it? (Sorry for the randomness/mixed thoughts of my post)

You mean the studentdoctornetwork website?

Lovely bunch aren't they :chuckle

Z

live4today, RN · May 21, 2005

I'll page the docs when I feel the situation warrants paging them. Their getting upset is NOT my issue. :rolleyes: If they don't want to be contacted, they should get out of medicine.

zacarias, ASN, RN · May 23, 2005

At the last hospital that I worked at in a medium-size city, actually would be expected to ask all the other nurses if they needed to talk to Dr. so-and-so if we called him. That I guess is not bad and I guess it makes it nicer for the Doctor. But I really couldn't believe it when a charge nurse told me to call ICU (I'm on tele) two floors down and ask them if they needed to the doctor I was calling after I was done!!